Towards The Eradication Of Hepatitis B In Taiwan
A Discussion Paper
Dr. Suzanne Wait

Table of Contents 

Foreword

Executive Summary
I.         Introduction: Hepatitis B in Taiwan

II.        What is hepatitis B?
Who is at risk of becoming infected?
Natural history
A silent disease
Liver cancer
A significant economic burden

III.       Managing hepatitis B disease: prevention, screening and treatment
Vaccination: the most effective prevention
Targeted prevention of high-risk groups
Screening
Diagnosis
Monitoring
Treatmen

IV.      Challenges to containing hepatitis B in Taiwan
A huge success story...
...Yet challenges remain:
1.    Need for greater awareness and education
2.    Need to ensure continued success of the vaccination programme
3.    Need to improve standards of care for the management of hepatitis B
4.    Need to overcome geographic and social inequities in access to care

V.       The way forward 

VI.      References

Foreword 

Viral hepatitides have long been important public health problems in humans. The etiologic agents were not identified, until around 1965 when Baruch S. Blumberg first found the relationship of Australia antigen and serum hepatitis. Further characterizations revealed the antigen to be the surface antigen of the hepatitis B virus. This epoch-making observation launched a new era in the diagnosis, prevention and treatment of hepatitis B. In about 15-20 years, the natural history of hepatitis B virus infection was elucidated, and more importantly, an effective vaccine against the infection became available. In the meantime, the routes of transmission were also made clear, rendering interruption of the transmission more specific and effective. The hepatitis B vaccine together with the effective means of interrupting the transmission routes contributed greatly to the control of hepatitis B virus infection. However, these measures can do very little to those who have already been chronically infected. Fortunately, specific therapies against chronic hepatitis B have started to appear about 10-15 years before and the treatments improved substantially in the last few years. Although far from perfect, now we do have some effective means to treat those who are chronically infected.
In Taiwan, acute and chronic liver diseases have been known to be rampant in as early as the beginning of the last century. Studies around 1975 showed an extreme high prevalence of chronic hepatitis B infection in the general population (15%-20%), and 80%-90% of the chronic liver diseases as well as hepatocellular carcinoma were caused by chronic infection with the hepatitis B virus. This important health problem, repeatedly addressed by the academia in Taiwan, finally caught the attention of the Government in the late 1970s, and a government-sponsored control program was finalized in 1981. Accordingly, a mass vaccination program against hepatitis B, primarily aiming at immunizing newborn infants, was launched on July 1, 1984. Twenty years after implementation of the program, the hepatitis B carrier rate in children covered by the program decreased 85%, from ~15% to <1%. Most importantly, the deadly sequela of hepatocellular carcinoma in the vaccinees was also found to decrease in parallel . This is the first time in history that a human cancer is prevented by vaccination. Despite the success, there are still some who were born after implementation of the program but were not prevented from chronic hepatitis B infection and hepatocellular carcinoma. Non-compliance to vaccination schedule, breakthrough infection and intrauterine infection are the causes of the failure.
At present, we have effective measures in immunizing the susceptibles, interrupting the routes of transmission and treating the chronically infected people. The time of considering elimination or even eradication of hepatitis B virus infection has come. This is especially true for countries where hepatitis B infection is not endemic. Nevertheless, with the admirable results achieved in the past, Taiwan should also start to think about elimination/eradication of hepatitis B in the country, even though it will certainly be much more difficult than in the non-endemic countries.
Dr Suzanne Wait has spent substantial efforts and time in exploring the possibility of eliminating/eradicating hepatitis B in Taiwan. She reviewed the epidemiology of hepatitis B, and analyzed the problems that remain to be tackled in Taiwan. With this essay as an important reference, I hope that Taiwan can take further steps towards the elimination or eradication of hepatitis B.

Ding-Shinn Chen, M. D.
Distinguished Chair Professor
Division of Gastroenterology and Hepatology
Department of Internal Medicine
National Taiwan University College of Medicine

Staff Physician
Hepatitis Research Center
National Taiwan University Hospital
7 Chung-Shan South Road

April, 2010 Taipei 10002, TAIWAN

Download full paper:

110711 Eng-Wait Briefing Document HepB in Taiwan (376 KB DOC)
110711 中文版-Wait Briefing_Document_HepB_in_Taiwan (236 KB DOC)
FaLang translation system by Faboba

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NOhep is a global, grassroots movement aimed at bringing all stakeholders together to eliminate viral hepatitis by 2030. It has been developed to create global awareness of the disease, similar to the red ribbon for HIV/AIDS, and was launched in 2016. NOhep firmly positions itself at the forefront of the elimination conversation, showcasing exemplary leadership, fostering on-the-ground innovative solutions and taking action to support the policy changes needed to eliminate this cancer-causing illness by 2030. Being a part of NOhep means being part of the solution. (To find out more about the development of this exciting initiative, watch this short video: https://youtu.be/Oer-rGwnKZU

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>> 基本概况
病毒性肝炎
全球约有20亿乙肝病毒(HBV)携带者。
由该病毒所致之急性或慢性肝病,平均每
年夺取约60万人生命
如果未经有效治疗,患慢性丙肝及其他
进展性肝病(如肝硬化)之患者比例至2015
年将大幅提升百分之三十八。
目前并无丙肝预防疫苗问世,但约80%
患者可经有效针对性治疗而获痊愈
                                          >>更多信息
>> 视频录影资料
病毒性肝炎所致之全球性健康危害

 

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